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Section 3
Parenting and Prenatal Risk

Question 3 | Answer Booklet | Table of Contents

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In the last section, we discussed four secondary disabilities frequently found in FASD clients.  These three secondary disabilities included: mental health; frequent troubles with authoritative institutions; alcohol abuse; and inappropriate sexual behavior.

In this section, we will examine FASD in the early stages of life and the most effective familial structure for them. The three stages we will examine in this section include:  infancy; toddlers and preschool years; and school-age years. The three types of familial structure during these stages are, respectively: soothing atmospheres; developing communication skills; and clear demands.

3 Early Stages of Life & Familial Structures During these Stages

♦ Stage #1 - Infancy
The first stage is infancy.  Infancy is a time for identification and protection. Infants diagnosed with FASD have an array of physical complications that are associated with the disease but not necessarily diagnostic of it. These include heart defects, organ and skeletal malformations, hip displacement, scoliosis, and seizures. These types of conditions need to be frequently screened. In addition, FASD infants frequently have trouble habituating. 

These FASD infants become overwhelmed by stimuli and respond by crying, fidgeting, squinting, and other indications of agitation. This, I have found, is the most common manifestation of the damage done to the central nervous system and is one of the earliest indications for FASD. Children who become frequently over stimulated have greater risks of secondary disabilities.

♦ Technique:  Soothing Atmosphere
Sherri and Paul knew that their adopted daughter Blaise had had FASD at the time of her birth.  Since then, they have been trying to frequently stimulate her in order to improve her IQ in later years. Sherri stated, "I don’t want her to be dumber than the other children. I’m always showing her new colors and playing her music, but she doesn’t seem to like that. She squirms and cries the entire time." 

I stated to Sherri and Paul, "Although I know it is tempting to surround your infant with sights and sounds in order to enhance development, it is much more useful to provide a calm, modulated environment for infants with FASD. This environment should be predictable and soothing, not overwhelming. In short, an environment that is interactive with Blaise’s own responses, respectful of her needs, and oriented toward helping her immature nervous system develop better regulatory control." 

To better create a soothing atmosphere for Blaise, Sherri and Paul installed dimmer lights and kept the noise level in their home to a minimum. The music Sherri played for her was now soft and sometimes only consisted of Sherri’s voice. Think of your Sherri and Paul. Is the environment in their home too overwhelming for their FASD infant?

♦ Stage #2 - Toddlers and Preschool Years
The second stage involves toddlers and preschool years. During this stage, the clients appear petite, bright-eyed and socially engaging. So much so that many parents are compelled to believe that their son or daughter are "being cured." They begin to believe that the child will be fine when he or she finally grows up. 

However, I try to caution parents to listen carefully to the child’s own behaviors for guidelines for interventions and planning.  On the other end of the spectrum, some clients with FASD are already out of control as preschoolers. Violent behavior directed toward self or others, fire-setting, marked hyperactivity, and incorrigibility are all signs of extreme FASD. 

♦ Technique:  Developing Communication Skills
Neal, age 4, was an extremely rambunctious child. Unrestrained, he would kick and yell whenever someone came into the room as a way of communication. Although he may not be angry, Neal preferred to communicate through his physical expressions. The first time I met Neal, he tried to kick my shins. However, by his facial expressions, I could tell that he did not mean to hurt me, but rather express his excitement at meeting a new person. I stated to Neal, "Kicking me is a strange way to say good morning." 

I explained to Neal’s parents, Denise and Robert, that I was trying to demonstrate how to verbalize the appropriate communication for an inappropriate social interaction. I asked Denise and Robert to reiterate to Neal the importance of using words rather than physical expressions to show excitement. This facilitates the expression of the client’s needs to the outside world and prevents the client becoming frustrated.

Another important aspect of developing communication skills with clients like Neal is teaching them how to ask for help. Although self-sufficiency is an obvious enduring goal of childhood, the concept of asking for help when needed is, I feel, and extremely helpful technique for situations across the life span. Part of the equation in learning to ask for help is learning to recognize when a task is too hard to achieve alone. The other part of the equation is knowing that help is available when asked for.

♦ Stage #3 - School-Age Years
In addition to infancy and toddlers and preschool, the third stage involves the school-age years.  Adjustment to the school structure can be daunting for many FASD children if they are not approached in the correct way. Repeated failure, peer pressure and baiting, inability to understand the demands of the task, and insufficient time to complete the task can all contribute to a vulnerable child’s loss of control. Yelling, throwing something, and stomping out of the room can all be manifestations of loss of behavioral control. 

The basic cognitive, attention, and memory problems of FASD clients set the stage for behavior problems at home and in the classroom. Basic communication problems and difficulty with self-reflection make verbal communication of needs difficult. The clients become overwhelmed by stimulation and are unable to either respond appropriately or protect themselves from the over stimulation of competing and ambiguous demands. 

When they lose control, they are likely to be punished for their unacceptable behavior while the basic problem underlying their lack of compliance is ignored.

♦ Technique:  Clear Demands
Brandon, age 8, was having trouble understanding the directions of his teacher. He acted out after becoming too overstimulated and was subsequently punished. The teacher, aware of Brandon’s FASD but uneducated about the condition, was a poor caregiver. I recommended to his parents, Michael and Ruth, that I contact the school counselor regarding providing the teacher with some FASD basic. 

8 Methods to Facilitate Learning
I also asked Michael and Ruth to remember the following techniques to facilitate Brandon’s learning abilities:

1. Keep instructions calm, clear, and short
2. Set the stage for success and not failure
3. Teach with both verbal and visual modalities
4. Break tasks into steps
5. Keep the situation from getting out of control
6. Encourage the verbalization of needs
7. Avoid the kind of questioning that makes the client without answers feel as if they are "on the spot"
8. Provide help and support rather than employing shame and guilt for failure.

By structuring Brandon’s environment, he will find it much easier to adapt to increasing demands as long as there is a controlled element to the situation

In this section, we discussed FASD in the early stages of life and the most effective familial structure for them.  The three stages we will examine in this track included:  infancy; toddlers and preschool years; and school-age years.  The three types of familial structure during these stages are, respectively:  soothing atmospheres; developing communication skills; and clear demands.

In the next section, we will examine three aspects of adolescents with FASD.  These three aspects of adolescents with FASD include:  difficulties; independence with structure; and help for parents.
Reviewed 2023

Peer-Reviewed Journal Article References:
Barr, H. M., Streissguth, A. P., Darby, B. L., & Sampson, P. D. (1990). Prenatal exposure to alcohol, caffeine, tobacco, and aspirin: Effects on fine and gross motor performance in 4-year-old children. Developmental Psychology, 26(3), 339–348.

Huizink, A. C. (2015). Prenatal maternal substance use and offspring outcomes: Overview of recent findings and possible interventions. European Psychologist, 20(2), 90–101.

Key, K. D., Ceremony, H. N., & Vaughn, A. A. (2019). Testing two models of stigma for birth mothers of a child with fetal alcohol spectrum disorder. Stigma and Health, 4(2), 196–203.

Marceau, K., Rolan, E., Leve, L. D., Ganiban, J. M., Reiss, D., Shaw, D. S., Natsuaki, M. N., Egger, H. L., & Neiderhiser, J. M. (2019). Parenting and prenatal risk as moderators of genetic influences on conduct problems during middle childhood. Developmental Psychology, 55(6), 1164–1181.

Young, I. F., Sullivan, D., & Hamann, H. A. (2020). Abortions due to the Zika virus versus fetal alcohol syndrome: Attributions and willingness to help. Stigma and Health, 5(3), 304–314.

QUESTION 3
What are three types of familial structure techniques? To select and enter your answer go to Answer Booklet.